Provider Demographics
NPI:1194928259
Name:MARTIN, CHERYL MAE (MED,IECE)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MED,IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7822 HIGHWAY 2004
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-8397
Mailing Address - Country:US
Mailing Address - Phone:606-965-2158
Mailing Address - Fax:606-965-2158
Practice Address - Street 1:7822 HIGHWAY 2004
Practice Address - Street 2:
Practice Address - City:MC KEE
Practice Address - State:KY
Practice Address - Zip Code:40447-8397
Practice Address - Country:US
Practice Address - Phone:606-965-2158
Practice Address - Fax:606-965-2158
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist